Article type
Year
Abstract
Background: Since 2003, Venezuela has sent more than 15,000 Cuban
doctors, within a bilateral cooperation, to the shanty towns (barrios) in
order to provide primary health care (PHC) for the poor. This healthcare
intervention, called Barrio Adentro (into the quarter), has been the subject
of highly controversial and politicised debates. In 2006, the Pan American
Health Organization (PAHO/WHO) convoked an international team of
experts in order to compile a report providing objective data about this
healthcare intervention within a time frame of three months. Objectives:
To delineate Barrio Adentro and assess its impact on health during the first
two years of implementation. Methods: Quantitative and qualitative
analysis of data collected from key players, in-depth interviews, and field
visits. Results: Access: Through the creation of 8613 new consultation
points, Barrio Adentro achieved free access to PHC for a population that
was previously excluded from it. This included dental and basic ophthalmological
care. Equity: In areas with lower human development index
(HDI), the average number of inhabitants per physician improved
more than in states with higher HDI. Sustainability and participation:
Approximately 17,000 medical students enrolled in the study programme
of comprehensive community medicine. Health promotion strategies
included the training of about 140,000 health promoters. Health
committees established patient and health education groups all over the
country. Child mortality: Since 1996, infant mortality rate has decreased,
falling from 18.5 per 1000 live births in 2003 to 15.5 in 2005.
Conclusions: Results show that a model for PHC based on demand
rather than on free-market fundamentalism is feasible. The report
represents a retrospective, rapid health impact appraisal under resourceconstrained
conditions. It emphasises participation, equity, sustainable
development, and ethical use of evidence as described in the Gothenburg
Declaration on Health Impact Assessment (1999). As Barrio Adentro was a
broad-scale intervention in the phase of implementation, the precise
impact of the various parts of the policy on specific health parameters
could not be determined. Further discussion about future assessment and
monitoring of the health impact of Barrio Adentro is needed.
doctors, within a bilateral cooperation, to the shanty towns (barrios) in
order to provide primary health care (PHC) for the poor. This healthcare
intervention, called Barrio Adentro (into the quarter), has been the subject
of highly controversial and politicised debates. In 2006, the Pan American
Health Organization (PAHO/WHO) convoked an international team of
experts in order to compile a report providing objective data about this
healthcare intervention within a time frame of three months. Objectives:
To delineate Barrio Adentro and assess its impact on health during the first
two years of implementation. Methods: Quantitative and qualitative
analysis of data collected from key players, in-depth interviews, and field
visits. Results: Access: Through the creation of 8613 new consultation
points, Barrio Adentro achieved free access to PHC for a population that
was previously excluded from it. This included dental and basic ophthalmological
care. Equity: In areas with lower human development index
(HDI), the average number of inhabitants per physician improved
more than in states with higher HDI. Sustainability and participation:
Approximately 17,000 medical students enrolled in the study programme
of comprehensive community medicine. Health promotion strategies
included the training of about 140,000 health promoters. Health
committees established patient and health education groups all over the
country. Child mortality: Since 1996, infant mortality rate has decreased,
falling from 18.5 per 1000 live births in 2003 to 15.5 in 2005.
Conclusions: Results show that a model for PHC based on demand
rather than on free-market fundamentalism is feasible. The report
represents a retrospective, rapid health impact appraisal under resourceconstrained
conditions. It emphasises participation, equity, sustainable
development, and ethical use of evidence as described in the Gothenburg
Declaration on Health Impact Assessment (1999). As Barrio Adentro was a
broad-scale intervention in the phase of implementation, the precise
impact of the various parts of the policy on specific health parameters
could not be determined. Further discussion about future assessment and
monitoring of the health impact of Barrio Adentro is needed.